SATUAN ACARA PENYULUHAN (SAP)

“ADOLESCENT ANEMIA” AT SMPN 15 SURABAYA

Lecturer:

Mrs. Sari Lutfiyah, S.Kp.,SST.,M.Kes

Created By :

Chelsea Anggraini (P27824420147)

MINISTRY OF HEALTH THE REPUBLIC OF INDONESIA

HEALTH POLYTECHNIC MINISTRY OF HEALTH IN SURABAYA

DEPARTMENT OF MIDWIFE

SUTOMO APPLIED MIDWIFE STUDY PROGRAM

YEAR ACADEMIC 2022

 VALIDITY SHEET
Report of Health Education Events English Language Practice Activities in Midwifery, 15th
semester of Midwifery, held by students in the 5th semester of Midwifery Junior High School in
Surabaya on 13 September Midwifery Department of Midwifery Sutomo Surabaya in the 2022
academic year.

Surabaya, 11 September 2022

Chelsea Anggraini
(P27824420147)

Land Supervisor Education Advisor Education Advisor

Eka Sofiana, S.Pd Kharisma K. S.SiT., M.Keb Siti Mar'atus S, SST., S.Pd.M.Kes
NIP. NIP. 198103232008012014 NIP. 197112251992032004

Knowing,
the Head of the Applied Midwifery Study Program, Sutomo

Dwi Purwanti S.Kp., SST., M.Kes

NIP. 196702061990032003
 BACKGROUND

Anemia is a major health problem that occurs in the community and is often found throughout
the world, especially in developing countries such as Indonesia. These disorders cause chronic
disability which has a major impact on health, economic and social welfare conditions. Anemia is
more common in adolescent girls than adolescent boys. This happens because young women lose
iron (Fe) during menstruation so they need more iron (Fe) intake. The behavior of adolescent girls
who consume more plant-based foods results in their iron intake not meeting their daily iron needs
(Triwinarni, Hartini, & Susilo, 2017).

The world population who suffers from anemia is about 30% or 2.20 billion people, with most
of them living in the tropics. The prevalence of anemia globally is around 51% (Suryani, Hafiani,
& Junita, 2017). WHO data in the Worldwide Prevalence of Anemia shows that the total world
population who suffers from anemia is 1.62 billion people with a pre-school age prevalence of
47.4%, school age 25.4%, women of childbearing age 41.8% and men 12, 7% (WHO, 2008). The
Ministry of Health of the Republic of Indonesia (2013) shows that the national prevalence of
anemia in all age groups is 21.70%. The prevalence of anemia in women is relatively higher
(23.90%) than men (18.40%).
Several factors related to the incidence of anemia in adolescent girls, namely energy intake,
protein intake, iron intake, vitamin C intake, tea or coffee drinking habits, worm investment,
knowledge, education and type of parental occupation, family income, and menstrual patterns.
Anemia causes insufficient blood to bind and transport oxygen from the lungs to the rest of the
body. If the oxygen needed is not enough, it will result in difficulty concentrating, low physical
endurance, decreased physical activity (Astrida Budiarti, 2020).
The program for giving blood-added tablets for teenagers is again being encouraged with a
national target of giving it. Adolescent girls receive blood supplement tablets with a preventive
dose of 1 time a week and 1 time a day during menstruation. However, the facts in the field of
blood-added tablets only focus on pregnant women, while for young women it has not been carried
out optimally.
Anemia is a medical condition in which the number of red blood cells or hemoglobin is
less than normal. Normal hemoglobin levels are generally different in men and women. For
men, anemia is usually defined as a hemoglobin level of less than 13.5 g% and in women as
hemoglobin less than 12.0 g%. Based on data from all age, women have the prevalence of anemia,
including young women. Adolescent girls will normally experience blood loss through
menstruation every month. Along with menstruation will be issued a number of iron needed for
the formation of hemoglobin. This is one of the causes of the high prevalence of anemia in
adolescent girls. Adolescent girls have a higher risk of anemia than young men. The first reason is
because every month young women experience menstruation. A woman who experiences heavy
menstruation for more than five days is feared to lose iron, so she needs more iron replacement
than a woman whose menstruation is only three days and a little. The second reason is because
young women often maintain their appearance, the desire to stay slim.
 SATUAN ACARA PENYULUHAN (SAP)

ADOLESCENT ANEMIA

Subject : Anemia
Sub-topic : Adolescent Anemia
Target : Adolescent (Students of SMPN 15 Surabaya)
Day/Date : Tuesday, 13th September 2022
Time : 12.20 – 12.40
Place : SMPN 15 Surabaya
By : Chelsea Anggraini

I. General Purpose
After participating in the counseling activities, it is hoped that adolescents will be able to follow
and understand and overcome the problem of anemia.
II. Special purpose

After participating in the counseling activities, it is hoped that adolescents will be able to
understand about:

- Definition of Youth

- Definition of Anemia

- Causes of Anemia in Adolescents

- Signs and Symptoms of Anemia

- The Effect of Anemia in Adolescents

- Prevention of Anemia

III. Material
Attached
IV. Method
1. Lecture
2. Question and Answer (Q&A)
 V. Media
Leaflet
Power Point
VI. Extension Activities
No. Stages of the Time Extender Target Activities Media
Event
- Greet and introduce yourself - Reply to greetings Leaflet
- Explain the purpose of counseling - Pay attention and answer
1. Introduction 1 minute - Exploring the knowledge of questions
participants regarding the - Distributing Leaflets
information picture to be conveyed
- Understanding Adolescence Listen and pay attention Power
- Understanding Anemia point
- Causes of Anemia in
Adolescents
2. Opening 15 minute
- Signs and Symptoms of Anemia
- symptoms of Anemia in
Adolescents
- Anemia Prevention
- Evaluation Ask and repeat the material Raise
3. Evaluation 5 minute - Ask and answer questions presented briefly and hand
answer questions
- Giving closing greetings and Reply to greetings
4. Termination 2 minute
thank you

VII. Evaluation
a. Counseling is carried out properly and on target
b. All material are presented in full
c. Promotional media used is complete (Leaflet)
d. The target is actively answering the given question
e. The target is able to explain again about anemia
VIII. References

Diananda, A. (2018). Psikologi Remaja dan Permasalahannya. Jurnal Istighna, Vol 1 Nomor
1

Puspikawati, S, I,. dkk. (2021). Pendidikan Gizi Tentang Anemia pada Remaja di Kecamatan
Banyuwangi Jawa Timur. Jurnal Media Kesehatan Masyarakat, Vol 10 Nomor 2 (278-
283).

Junita, D., Wulansari, A. (2021). Pendidikan Kesehatan tentang Anemia pada Remaja Putri
d SMAN 12 Kabupaten Merangin. Jurnal Abdimas Kesehatan (JAK), Vol 3 No 1.

Nasruddin, H., dkk. (2021). Angka Kejadian Anemia Pada Remaja Indonesia. Jurnal Ilmiah
Indonesia, Vol 1 Nomor 4 (357-364).

Yuniarti., Zakiah. (2021). Anemia pada Remaja Putri di Kecamatan Cempaka Kota
Banjarbaru. Jurnal Inovasi Penelitian, Vol 2 Nomor 7 (2253-2262).

Handayani, I. F,. dkk. (2021). Kejadian Anemia Pada Remaja Putri di SMP Budi Mulia
Kabupaten Karawang Tahun 2018. Muhammadiyah Journal of Midwifery , Vol 2
Nomor 2 (278-283).
Attachment 1 : Material

COUNSELING MATERIAL
ADOLESCENT ANEMIA
1. Definition of Adolescent
According to WHO, adolescents are residents in the age range of 12-21 years,
according to the Regulation of the Minister of Health of the Republic of Indonesia Number
25 of 2014, adolescents are residents in the age range of 10-18 years and according to the
Population and Family Planning Agency (BKKBN) the age range of adolescents is 10-18
years. 24 years old and unmarried. Adolescence is a period of transition or transition from
children to adulthood. At this time so rapidly experiencing growth and development both
physically and mentally (Diananda, A., 2018).

2. Definition of Anemia
Anemia (in Greek: Without blood) is a condition when the number of red blood cells
or the amount of hemoglobin (oxygen-carrying protein) in red blood cells is below normal.
Red blood cells contain hemoglobin which allows them to carry oxygen from the lungs,
and deliver it to all parts of the body. Anemia causes a decrease in the number of red blood
cells or the amount of hemoglobin in red blood cells, so that the blood cannot carry oxygen
in the amount needed by the body (Junita, D., 2021).
According to the World Health Organization (WHO, 1997) the Hb level limit for
adolescent girls for the diagnosis of anemia is when the hemoglobin level is less than 12
g/dl. While the criteria for anemia in Indonesia (in hospital or clinical practice) are
categorized as anemia if the hemoglobin level is less than 10 g/dl.

3. Causes of Anemia in Adolescent

Anemia is the impact of nutritional problems in adolescent girls. Nutritional anemia is
caused by a lack of nutrients that play a role in the formation of hemoglobin, it can be due
to lack of consumption or impaired absorption. These nutrients are iron, vitamin B6 protein
which acts as a catalyst in the synthesis of hemoglobin in the hemoglobin molecule, vitamin
C, zinc which affects the absorption of iron and vitamin E which affects the stability of cell
membranes in the blood. Most of them are iron nutritional anemia. The cause of iron
nutritional anemia is a lack of iron intake, especially in the form of iron-hemoglobin. In
addition, young women often consume food obtained through snacks in stalls or online
outside the dormitory environment where the food does not contain iron. There are also
teenage girls who skip breakfast, arguing that they are late for school or feel reluctant to
eat breakfast. In addition, some young women still lack knowledge about Fe consumption,
as well as the benefits of taking Fe tablets regularly. Education, evaluation and monitoring
from the school is very important related to Fe tablet supplementation, what is an Fe tablet,
what are the benefits, how to get it, how to take it, what substances can inhibit its absorption
and others (Ida Farida Handayani, 2021).
Below are some factors that affect anemia in adolescents are:
a. Lack of Knowledge and Health Sciences The low knowledge of adolescents on
health issues and health sciences. For them, health is not the main thing that should
be a concern. You still feel young so you don't have to take care of your health.
b. Blood loss caused by menstrual bleeding.
c. Lack of iron, vitamin B 12, folic acid, vitamin C in the food consumed.
d. Diseases such as tuberculosis, hepatitis, gastritis, appendicitis, etc.
e. Teenagers' lifestyle changes from being completely regular to being less regular,
for example, often eating late or not getting enough sleep.
f. Imbalance between nutritional intake and activities performed.
g. Worms, especially hookworms that can cause bleeding in the intestinal wall even
though a little but occur continuously which causes iron loss.
h. Reducing the portion of eating the desire to have a body like a model and the stars
so that you don't want to eat a lot. If this continues, it can lead to suffering from
anorexia nervosa, bulimia, and other mental disorders.
i. Lack of Socialization of Nutrition for Adolescents This problem can be overcome
if, from a young age, parents and adults around teenagers provide examples of
healthy living and provide adequate knowledge about nutrition and other nutritional
sciences.
4. Signs and Symptoms of Anemia
Adolescents who experience signs and symptoms of anemia can be measured by
measuring hemoglobin levels using an Auto hematology analyzer carried out by laboratory
personnel. Weight scales and height tools are used to measure BMI, while the independent
variable is anemia in adolescent girls. The independent variable is nutritional status based
on anthropometric measurements (BMI calculation, weight measurement, height) (Ida
Farida Handayani, 2021).
Signs and symptoms of anemia in adolescent girls:
a. easily weak, lethargic, tired, tired, and helpful
b. pale face,
c. not excited,
d. Easily sleepy, innately wants to sleep and feels weak all the time
e. It's easy to get dizzy, the body is floating, and the brain is difficult to digest information
f. Dizzy view
g. If it continues, it could easily cause other diseases

5. The Effect of Anemia

The impact of anemia in adolescents can cause delays in physical growth, behavioral
and emotional disorders. This affects the process of growth and development of brain cells
so that it can cause decreased body resistance, easy weakness, hunger, disturbed learning
concentration, decreased learning achievement and can result in low work productivity
(Ugi Sugiarsih, 2021).
Some of the other effects of anemia in adolescent girls:
a. Lowering the body's resistance so that teenagers who suffer from anemia can easily
get sick.
b. Inhibits physical growth and brain intelligence.
c. Intelligence level: namely the ability to achieve achievement in school and various
fields of life, including social, technical, trade, household arrangements.
d. Special talents are abilities that stand out in a field, such as mathematics, foreign
languages.
 e. Cognitive organization shows the material that has been studied, stored in memory
systematically or not.
f. Language ability.
g. Fantasy power has creative, anticipatory, recreational, and social uses.
h. Learning style.
i. Techniques or ways to learn efficiently and effectively.

6. Anemia Prevention
The role of midwives in addition to the above can also provide motivation to
adolescents, where they are prospective mothers in the future, who will experience a natural
reproductive cycle, go through pregnancy, childbirth, postpartum, breastfeeding, where
complications are likely to occur in future. This period can be prevented from an early age,
namely by making sure the teenager is not anemic. Adolescents who are not anemic are
expected when approaching adulthood, marry, become pregnant, give birth, breastfeed, and
are not anemic, without anemia, it will reduce the risk of complications, thus indirectly
contributing to the reduction in morbidity and mortality rates for mothers and babies. The
goal of care was achieved, namely the mother and baby in a safe, healthy and prosperous
condition. Anemia is something that can be prevented, it is never too late to prevent it, with
a good supply of nutrition since adolescence and assisted by regular supplementation of Fe
tablets, it is hoped that Indonesian young women can be free from anemia.
Adolescents need optimal nutritional intake for growth and development. Nutrition is
a process by which organisms use food that is consumed normally through digestion,
absorption, transportation, storage, metabolism and the release of substances that are not
used to maintain life, growth and produce energy. A balanced nutritional diet consists of
energy substances such as bread, flour, sources of building blocks such as fish, eggs,
chicken, meat, milk, nuts, tofu, tempeh, and sources of regulatory substances such as
vegetables, fruits, none dietary restrictions, do not do a slim diet. Teenagers really need
iron intake to form red blood cells. Iron is needed in the formation of blood and the
synthesis of hemoglobin. The menstrual process results in a lack of iron in the blood, so
that adequate nutritional intake is needed in adolescents (Ida Farida Handayani, 2021).
 Vitamin C increases the absorption of iron which plays an important role in the
functioning of your body. Iron helps make hemoglobin, the part of red blood cells that
carries oxygen. Vitamin C also helps in the production of red blood cells. Vitamin C
deficiency can cause anemia, or low blood cell counts. Sources of vitamin C are vegetables
and fruits, especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and
similar fruits. Fresh and frozen fruits, vegetables and juices usually have more
vitamin C than canned ones. Vitamin C deficiency can occur if you do not get enough
vitamin C from the food you eat. Vitamin C deficiency is also possible if something
interferes with the ability to absorb vitamin C from food. For example, smoking interferes
with the body's ability to absorb vitamin C. Folic acid and vitamin C are treated to
prevent anemia.

The Ministry of Health has developed an anemia prevention and control program for
young women and brides-to-be which is carried out independently in several areas to
improve pre-pregnancy health and nutrition status in preparation for a mother so that she is
not anemic and gives birth to a healthy baby. The program is in the form of supplementation
of Blood Add Tablets (TTD) once a week throughout the year, as a whole. The
government's efforts to prevent and increase iron reserves in the body, by providing iron
tablets. This supplementation contains at least 60 mg of elemental iron and 400 mcg of
folic acid. This supplementation is carried out in several settings such as health service
facilities, educational institutions, workplaces and KUA/other places of worship (Ugi
Sugiarsih, 2021).

Important actions taken to prevent iron deficiency include:

a. Counseling to help choose foods with adequate iron levels on a regular basis in
adolescence.
b. Increase iron consumption from animal sources such as meat, fish, poultry, seafood
accompanied by drinking fruit juices containing vitamin C (ascorbic acid) to increase
iron absorption and avoid or reduce drinking coffee, tea, iced tea, carbonated soft drinks
and drinking milk at mealtime.
c. Iron supplementation. It is a way of dealing with ADB in high prevalence areas. Giving
iron supplementation to adolescents at a dose of 1 mg/KgBW/day.
d. To increase iron absorption, iron supplementation should not be given with milk,
coffee, tea, soft drinks containing carbonate, multivitamins containing phosphate and
calcium.
e. Anemia screening. Hemoglobin and hematocrit tests are still the options for screening
for iron deficiency anemia.
Attachment 2 : Media (Leaflet)